Levels of prolactin, a hormone associated with milk production, did not rise in a retrospective chart review of nearly 100 transgender (male to female) patients receiving feminizing hormone therapy, alleviating concerns about a possible side effect, a Mount Sinai researcher has found.

Levels of prolactin, a hormone associated with milk production, did not rise in a retrospective chart review of nearly 100 transgender (male to female) patients receiving feminizing hormone therapy, alleviating concerns about a possible side effect, a Mount Sinai researcher has found.

Estrogen, part of the standard feminizing hormone therapy regimen, can stimulate prolactin levels, and medical guidelines recommend routinely checking prolactin levels in transgender patients receiving hormone therapy. Although the over production of prolactin isn’t life-threatening, it can impair vision and produce other side effects.

The study is the first to measure prolactin levels in transgender patients receiving the standard feminizing hormone therapy regimen that is used in the United States and is significant because it demonstrates that gender-affirming treatment for transgender people may be safer than recognized.

Results of the study were published in Endocrine Practice, the journal of the American Association of Clinical Endocrinologists.

Researchers examined estrogen, testosterone, and prolactin levels from 98 transgender women treated with estrogen therapy at the Endocrinology Clinic at Boston Medical Center. Up to six years of data were available for some patients. The researchers found no elevated levels of prolactin in any of the patients.

“Our data suggests that there may be no significant rise in prolactin when transgender women are treated with estrogen and that it may be unnecessary to monitor prolactin in patients receiving this treatment,” said the study’s lead author, Joshua Safer, MD, executive director, Center for Transgender Medicine and Surgery at Mount Sinai.

Safer says that this study adds to the slim body of evidence-based literature in transgender medicine.

“Significant knowledge gaps exist across all of the subspecialties in transgender medicine and there is a lack of prospective robust research and representation of transgender-specific data in the core medical journals,” said Safer. “Studies like this improve our knowledge of the best ways to treat this population.”

The sexual health risks for young adults are increasing through the use of dating websites and apps.

This is according to an original research by Zava, which found that 85% of 18-24 year olds have used dating apps. Unfortunately, of 2,000 respondents, 18% said they had caught an STI from someone they had met online, with chlamydia being the most common STI, with 10% of 18-24 year-olds catching the infection as a result of a meeting arranged through a dating app.

Interestingly, the rise in STIs like chlamydia and gonorrhea ought to be linked to lower levels of sexual health education; but as per Zava’s research, the opposite is true, with almost two thirds saying they feel informed about STIs.

The study also noted that young adults in rural areas are more likely to have been diagnosed with an STI as a result of their online activity than those in urban areas. Also, people who identify as gay are also more likely to have contracted an STI, with a third of young gay people testing positive for a sexually transmitted infections after meeting a partner online.

38% of people with an STI found out about the infection by noticing the symptoms, particularly for common STIs like chlamydia and gonorrhea rather than being told by the person they caught it from. Healthcare professionals suggest this could be partly due to the practice of people deleting the profiles of their previous partners, so they can’t always inform them if they are diagnosed with an infection later on.

As an FYI: The most popular dating app among the respondents was Tinder, with 70% having used it, way ahead of Bumble (6%), Grindr (4%), Happn (2%) and Hinge (1%).

In terms of STI testing, it seems that for young people, the decision to get tested isn’t related to public service advertising. Only 5% of the general population and 12% of people who identify as gay reported that public service advertisements were their primary reason for getting tested. Overall, people who identify as gay or bisexual are more likely to get tested for STIs (34% and 33% respectively) than their straight counterparts (28%).

Commenting on the findings, Dr Kathryn Basford of Zava, said: “Both gonorrhoea and chlamydia are bacterial infections that can have serious health consequences if they remain untreated. Prevention is much better than treatment, so we advise all young adults meeting people online to use a barrier contraceptive like condoms, femidoms, or dental dams. Not only can barrier contraceptives prevent unwanted pregnancies, unlike other forms of contraception they also reduce the risk of contracting an STI.”

Major medical associations agree that transgender individuals need to be able to express their gender in ways with which they feel comfortable and that this is the most effective treatment for psychological distress caused by incongruence between sex assigned at birth and gender.

For many transgender individuals, expressing their gender involves physically changing their body through medical steps such as taking hormone therapy.

However, transgender patients often experience difficulty getting hormone therapy prescriptions, to the point that one in four transgender women have to resort to illegally obtaining cross-sex hormones. Part of this is because existing research on transgender hormone therapy is limited and conflicting, which has led to some physicians denying patients this treatment out of concern that it could significantly increase the risk of health problems such as blood clots and cardiovascular disease.

A team of researchers led by Dina N. Greene, PhD, of the University of Washington in Seattle in the US estimated that in transgender women prescribed estrogen, blood clots only occur at a rate of 2.3 per 1,000 person-years. While this is higher than the estimated incidence rate of blood clots in the general population (1.0-1.8 per 1,000 person-years), it is less than the estimated rate in premenopausal women taking oral contraceptives (3.5 per 1,000 person-years), which means that it is an acceptable level of risk.

In order to determine this, Greene’s team performed a systematic review of all studies that have included the incidence rate of blood clots in transgender women receiving estrogen therapy, identifying 12 that were most relevant. The researchers then used meta-analysis to combine the results of these 12 studies and calculate a risk estimate that is based on all available evidence to date.

“Documenting the risks associated with hormone treatment may allow for prescribers to feel more comfortable with prescribing practices, allowing for better overall management of transgender people,” said Greene. “Our data support the risk of thrombotic events in transgender women taking estrogen therapy being roughly comparable to the risk of thrombotic risks associated with oral contraceptives in premenopausal women. Given the widespread use of oral contraception, this level of risk appears to be broadly accepted.”

In a second study, a team of researchers led by Guy G.R. T’Sjoen, MD, PhD, also conducted a systematic review of all studies that measured risk factors for cardiovascular disease in transgender people taking hormone therapy. The researchers identified 77 relevant studies in this area and found that the majority of them report no increase in cardiovascular disease in either transgender men or women after 10 years of hormone therapy. The studies that did indicate a higher cardiovascular disease risk for transgender women in particular mainly involved patients using ethinyl estradiol, a now obsolete estrogen agent, and are therefore no longer valid.

T’Sjoen’s team does state that their results are not conclusive due to the small sample sizes and relatively short duration of the studies in this area (and Greene’s team included a similar caveat for their work). However, it is important to look at Greene and T’Sjoen’s studies in the context of transgender research as a whole. The field only began to receive National Institutes of Health funding in 2017 and is also lagging due to the fact that transgender patients often aren’t identified in medical databases that provide data for research. In light of this, these studies are significant not only because they suggest that transgender hormone therapy is safe, but also because they underscore the need for longer-term, large scale studies involving this underserved population.

For this study, the researchers wanted to identify the optimal patient-centered approach to collecting sexual orientation and gender identity information in the emergency department (ED).

So they tapped four EDs on the east coast of the US that sequentially tested two different sexual orientation and gender identity (SOGI) collection approaches between February 2016 and March 2017.

A total of 540 enrolled patients were analyzed; the mean age was 36.4 years and 66.5% of those who identified their gender were female.

In particular, two SOGI collection approaches were tested: nurse verbal collection during the clinical encounter vs nonverbal collection during patient registration. The ED physicians, physician assistants, nurses, and registrars received education and training on sexual or gender minority health disparities and terminology prior to and throughout the intervention period.

Multivariable ordered logistic regression was used to assess whether either SOGI collection method was associated with higher patient satisfaction with their ED experience. Eligible adults older than 18 years who identified as a sexual or gender minority (SGM) were enrolled and then matched 1 to 1 by age (aged ≥5 years) and illness severity (Emergency Severity Index score ±1) to patients who identified as heterosexual and cisgender (non-SGM), and to patients whose SOGI information was missing (blank field). Patients who identified as SGM, non-SGM, or had a blank field were invited to complete surveys about their ED visit. Data analysis was conducted from April 2017 to November 2017.

In a gist (and to emphasize): Registrar form collection is the optimal patient-centered approach to collecting sexual orientation and gender identity information in the emergency department.

“Our interventional study assessing two potential methods to collect SOGI in the ED found that SGM patients reported significantly higher satisfaction with their experience in the ED with registrar nonverbal collection compared with nurse verbal collection,” the researchers stated. “In other words, SGM patients preferred a standardized collection process where all patients could report SOGI along with other demographical information vs being asked by a nurse during a clinical encounter. Non-SGM patients and those without reported SOGI information were no less satisfied with form collection compared with verbal collection.”

Image used for illustration purpose only; photo by Annie Spratt from Unsplash.com

Depressive symptoms are more common among sexual minority youth than heterosexual youth at age 10, develop faster during adolescence, and continue into young adulthood (even if they start to decline from age 18).

Previous research found that annually, in the UK alone between 2001 and 2014, on average across 10- to 19-year-olds, around 37 per 10,000 girls and 12 per 10,000 boys were treated for self-harm.

The findings suggest that sexual minority youth and are four times more likely to report recent self-harm at ages 16 and 21 years than their heterosexual peers, and are at higher risk of depressive symptoms from as young as 10 years old.

“We’ve known for some time that sexual minority youth have worse mental health outcomes, and it’s quite concerning that we’ve found this trend starts as early as 10 years old, and worsens throughout adolescence,” said the study’s senior author, Lewis.

To make for a robust sample of LGBQ youth, all participants who were not exclusively heterosexual were grouped into the same ‘sexual minority’ category, including 625 people (13%) who had described themselves as homosexual, bisexual, mainly homosexual, mainly heterosexual, unsure or not attracted to either sex.

The participants responded to questions about depressive symptoms seven times from age 10 to 21, and at 16 and 21 were asked if they had attempted to hurt themselves in the past year.

Depressive symptoms increased throughout adolescence in both groups but the increase was greater for sexual minority youth, who already were more likely to report depressive symptoms from age 10. Self-harm was more common among non-heterosexuals at both 16 and 21.

At age 18 years, the LGBQ adolescents were twice as likely to fulfil the criteria for a clinical diagnosis of depression.

Mental health outcomes were worse for each of the sexual minority groups compared to heterosexuals.

The researchers said that there may be numerous factors likely involved here.

“As these differences emerge so early, we suspect that a sense of feeling different might affect mental health before children can even articulate that difference. As they progress through adolescence, a range of stressors could be involved, such as discrimination, stigmatization, feelings of loneliness, social isolation, shame or fear or rejection, including at home or at school,” said the study’s first author, Irish.

The findings suggest that clinicians who encounter young people, whether in primary or secondary care, sexual health services, the emergency department, or as school nurses, should be mindful about sexuality in considering the wider context for depressive symptoms or self-harm.

“Clinicians should use language and questions that reflect openness about sexuality, and not assume heterosexuality, and they should be aware that a young person who identifies as not exclusively heterosexual may have struggled with mental health problems from early in development,” said co-author Pitman.

The fact we found mental health disparities at such a young age suggests that early interventions may be useful to prevent and treat such mental health challenges, Lewis said.

“Despite changes to public perceptions and attitudes in recent years, gay, lesbian and bisexual youth remain at increased risk of long-term mental health problems – addressing this inequality should be a research, policy, clinical and public mental health priority,” Lewis ended.

Gastroesophageal Reflux Disease (GERD) commonly known as acid reflux or heartburn is a very common digestive disease. It happens when acid from the stomach escapes into the esophagus, the aftereffect is felt as heartburns, pain, and inflammation.

The condition is noticed when the
barrier between the stomach and the esophagus becomes impaired, causing the
acid and food in the stomach to flow back into the esophagus. If not treated
over time, the reflux of stomach acid into the esophagus through the lower esophageal
sphincter can result in a more serious condition including throat cancer.

Acid reflux, unlike many other
medical conditions, can be almost completely preventable – that is if you do
the right thing. Acid reflux can cause sore throats and hoarseness and may
literally leave a bad taste in your mouth. The following steps will help you
reduce your symptoms of acid reflux.

1. Avoid Going to Bed After a Meal

Sleeping immediately after a meal one sure way to trigger acid reflux. Why? When you lie down (horizontally that is), you create a somewhat level field for the stomach acid and all that you’ve eaten to move freely into the esophagus. However, when you sit or stand, gravity help keeps the stomach acid in the stomach, where it belongs.

Sleeping immediately after a meal one sure way to trigger acid reflux. Photo by Alexandra Gorn from Unsplash.com

To prevent this, eat your meals at least two to three hours before lying down. This will give food time to digest and get out of your stomach. Furthermore, by this time, the acid level would have also gone down.

2. Get to Know Your Triggers and Run from Them

For every person living with acid reflux, there are certain foods which trigger this condition. Onions, peppermint, chocolate, beverages with caffeine, citrus fruits or juice, tomatoes, high-fat and spicy foods are some known culprits. The list of triggers is relative, as what can cause an explosive heartburn for one may just be digested normally in another.

Get a list of foods and how you react with them. You can rank the heartburn effect you feel after eating them using a scale of 1 to 5 or 1 to 10 or even 20.Photo by Brooke Lark from Unsplash.com

To help with this, we advise that
you get a list of foods and how you react with them. You can rank the heartburn
effect you feel after eating them using a scale of 1 to 5 or 1 to 10 or even
20. The lower numbers on the list should represent the foods that leave mild
heartburn symptoms.

It may take quite some time to get
a comprehensive list when you finally do, it becomes easier to control your
heartburn.

3. Reduce Your Mealtime Portions

Eating smaller meal portions is
also another way of controlling acid reflux. When you overstuff your stomach,
you give acid in the stomach no space – looking for where to stay, they move
into the esophagus. If you cannot manage the small meals three times a day, you
can eat up to four or five times a day. Just don’t overstuff your stomach.

4. Eat a Little Bit Slower

Even if it is not your thing, you may need to consider eating more slowly to control your acid reflux. By slowing down your eating you will end up with less food in your stomach at any one time. It takes time for the chemical messengers in our stomach to let the brain know we’re getting full. Give those messengers time to work, and your body will better tell you when you’ve had enough.

By slowing down your eating you will end up with less food in your stomach at any one time. It takes time for the chemical messengers in our stomach to let the brain know we’re getting full.Photo by Tim Mossholder from Unsplash.com

If you are a vigorous eater, you
can mix food with conversation to spend more time on each meal. As a final
resort, you can begin eating with your non-dominant hand. Unless you are
ambidextrous or created to eat with both hands, this can be an easy way to slow
down.

5. If You Do, Stop Smoking and Drink Moderately

While these are habits some consider cool and normal, they would worsen your heartburn. Cigarettes contain nicotine which will weaken the esophageal sphincter – the muscle saddled with the responsibility of controlling the opening between your esophagus and your stomach. When it’s closed, it keeps acid and other things in your stomach from going back up.

Alcohol increases the production of stomach acid and also relaxes the lower esophageal sphincter (LES).Photo by Thomas Picauly from Unsplash.com

While alcohol may be a great way of
blowing off steam after a stressful day, we recommend exercising, walking,
meditation, stretching, or deep breathing instead of turning to the bottles.
Alcohol increases the production of stomach acid and also relaxes the lower
esophageal sphincter (LES), allowing stomach contents to reflux back up into
the esophagus.

Taking alcohol may not leave the
same effect on everyone. If some people, a bottle is more than enough to trigger
reflux, others may be able to tolerate two, maybe three before the symptoms
surface. The important thing is that you know how much you can take before reflux,
and stick to it.

6. Use Medication

There are great medications to help
with your acid reflux. First are antacids which will typically work very
quickly on heartburn – but for a short period of time. Mylanta, Rolaids, and Tums, are common
Antacids. Next up are H2 blockers. These group of drugs will work for
a longer period of time, usually up to 12 hours. Cimetidine, Famotidine, nizatidine, and ranitidine.

Finally, we have proton pump inhibitors, and Omeprazole is one of the most popular of these. Omeprazole works by reducing the amount of acid that your stomach produces and so helps to reduce the symptoms associated with acid reflux. Omeprazole is an effective and established medicine for the treatment of acid reflux.

There are great medications to help with your acid reflux.Photo by Sharon McCutcheon from Unsplash.com

As a part of your medication, your
doctor may advise that you drop some weight. Many experts believe that extra
belly fat increases pressure on the stomach, forcing food and acid back up
through the esophagus. Please, do this only after your doctor has recommended.

7. Sleep on an Inclined Plane

To put it simply, elevate your bed – the bedposts to be exact. By raising your bedpost up to six or eight inches, you give gravity the chance to keep gastric acid down in your stomach. Avoid using pillows as this can put your head at an angle that can put more pressure on your stomach and make your heartburn worse.

To put it simply, elevate your bed – the bedposts to be exact.Photo by Tracey Hocking from Unsplash.com

Lesbian women less likely to receive birth control counseling, prescription

While lesbian women were less likely to report receiving a birth control prescription or birth control counseling compared with heterosexual women, they were more likely to report having received sexually transmitted infection (STI) counseling, testing, or treatment.

Image used for illustration purpose only; photo by Jairo Alzate from Unsplash.com

Lesbian women were less likely to report receiving a birth control prescription or birth control counseling compared with heterosexual women. However, they were more likely to report having received sexually transmitted infection (STI) counseling, testing, or treatment, after adjusting for sexual partners in the past 12 months.

This is according to a new study that used data from the National Survey of Family Growth 2006-2015, and published in Journal of Women’s Health, a peer-reviewed publication from Mary Ann Liebert, Inc.

Bethany Everett, PhD, University of Utah (Salt Lake City), and colleagues from the University of Wisconsin (Madison) and the University of Chicago (IL), investigated sexual orientation disparities in the use of sexual and reproductive health services and receipt of contraceptive counseling in clinical settings in the past 12 months.

The researchers found that, in a clinical setting, lesbian women were less likely to report receiving birth control counseling at a pregnancy test and lesbian women without recent male sex partners were less likely to report receiving counseling about condom use at an STI-related visit compared with heterosexual women.

“This new research emphasizes the importance of considering both sexual orientation and recent sexual behaviors when addressing the sexual and reproductive health needs of sexual minority women,” said Susan G. Kornstein, MD, editor in chief of Journal of Women’s Health and executive director of the Virginia Commonwealth University Institute for Women’s Health, Richmond, VA. “Using inclusive sexual and reproductive health counseling scripts may facilitate the delivery of appropriate sexual health-related information.”